J Pathol Transl Med.  2019 Jan;53(1):50-56. 10.4132/jptm.2018.11.30.

Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation

• Cho H
• Choi JO
• Jeon ES
• Kim JS

• KMID: 2437578
• DOI: http://doi.org/10.4132/jptm.2018.11.30

Abstract

BACKGROUND
The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients.
METHODS
A total of 1190 EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions, acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy was diagnosed by computed tomography coronary angiography. Clinical information, including the patients' survival was retrieved by a review of medical records.
RESULTS
Eighty-eight patients (75.2%) were diagnosed with Quilty lesions, which were significantly associated with acute cellular rejection, but not with acute cellular rejection ≥ 2R or antibody-mediated rejection. In patient sdiagnosed with both Quilty lesions and acute cellular rejection, the time-to-onset of Quilty lesions from transplantation was longer than that of acute cellular rejections. We found a significant association between Quilty lesions and cardiac allograft vasculopathy. No significant relationship was found between Quilty lesions and the patients' survival.
CONCLUSIONS
Quilty lesion may be an indicator of previous acute cellular rejection rather than a predictor for future acute cellular rejection.

Keyword

Quilty lesion; Endocardial inflammatory infiltrates; Acute cellular rejection; Cardiac allograft vasculopathy; Heart transplantation

MeSH Terms

Allografts
Biopsy*
Coronary Angiography
Heart Transplantation*
Heart*
Humans
Medical Records

Figure

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  Fig. 1. Quilty lesion and acute cellular rejection. (A) Quilty lesion. (B) Grade 1R. (C) Grade 2R. (D) Grade 3R.

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  Fig. 2. Antibody-mediated rejection. (A) Swollen endothelial cells and intravascular mononuclear cells. (B) Multifocal C4d staining in capillary endothelial cells. (C) CD 68 staining in intravascular macrophages (arrow).

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  Fig. 3. Then number of Quilty-positive endomyocardial biopsies (EMBs) for each biopsy order. The number of Quilty-positive EMBs increases as biopsy order increases.

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  Fig. 4. Time-to-onset from cardiac transplantation to acute cellular rejection (ACR) and Quilty lesions. The time-to-onset of Quilty lesion is significantly longer than that of acute cellular rejection.

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  Fig. 5. Kaplan-Meier analysis for disease-free survival (death, graft loss) in Quilty-positive and Quilty-negative patients. The difference in survival between Quilty-positive and Quilty-negative is not significant.

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